Confused about my doctors/consultants advice, am I type 1.5?

mrbondsbody

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I seem to symptom free of diketoacidosis and have been losing very slowly (0.1 kg per month) but that because I have not been overeating to get rid of the fat around my belly. Around 2000 calories per day. I heard dieting can increase your cholesterol.
 
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Spiker

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Transient high triglycerides during initial ketoadaptation. Don't ignore it but don't panic. Repeat test in say > 1 month.
 

Ian DP

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I am on a very low carb diet (5-15-80) and my total colestrial has increased, but importantky it is because of the increase on my good (HDL) colestrial which has improved my ratio. My HDL is now higher than my LDL...... This often seems to happen with LCHF.
 
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mrbondsbody

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I booked in for a retest at my GP surgery. The doctor said my test should have been done fasted so its likely the triglycerides were out of whack. However my LDL does seem very high and that wouldn't have been effected by non fasted conditions.

It would be after 1 month on the ketogenic diet so we'll see what affect it has had on my lipid profile.

Ian, how long did it take for your HDl to increase?

I got my cholesterol tested in FEB when I was diagnosed.

total cholesterol = 6.4 (FEB) to 8.0 (April)
LDL= 4.25 (FEB) to 4.91 (April)
HDL= 1.15 (FEB) to 1.22 (April)

Did not get my triglycerides, but I think they did not change
 

smidge

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@mrbondsbody - make sure you don't drink any alcohol the night before your blood tests - it plays havoc with the lipid profile - I don't know why but the two things that have the biggest impact on my cholesterol are exercise (improves lipid profile), alcohol (worsens lipid profile.

Smidge
 
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christi99

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It appears to me that the mechanism of complete or sudden destruction of beta cells in pancreas that precipitates the necessity of exogenous insulin (type 1), and the person who is showing decreased insulin release, production, and a combo of cellular resistance may be experiencing the same thing- just because their pancreas hasn't pooped out overnight. The reality is many type 1 diabetics are not followed prior to their diagnosis until a crisis occurs- so WHO KNOWS how long the path of destruction is taking in any one individual. But... my point is- biochemically- one needs to be able to transport energy into the cell using insulin and regardless of whether type 1 or 2 (or 1.5!)- you either take insulin, you take a drug that aids in its manufacturing and release from the pancreas, or you perhaps can manage by strict dietary, exercise regimen. Then- layer in the complex chemistry behind converting carbs, sugars, fats to energy can also be affected by exercise, even illness, infection, stress, whatever. SO... for ALL Diabetics, the diet you have should be optimizing the conversion of glucose/energy into food that get taken into the cell. At a slow steady rate- Really the very same mechanism whether you need insulin or not. Difference mainly is you will NEED food to occupy /bind to the insulin you injected yourself with or you will crash!!

I guess my point is that perhaps all diabetes is the result of auto-immune, or cellular destructive, inflammatory changes that result from many etiologies. Maybe we should be looking at how to identify factors that turn on auto-immunity, or toxic metabolic changes for all DM diagnosis (even with absence of antibodies). So seems that other than the meal to meal management-exogenous insulin requirement- the different forms of diabetes have essentially the same outcome and treatment goals systemically (and eventually).

As for the ketones associated with of a low carb/no carb/high fat diet diet- a non-insulin dependent person is usually only spilling ketones because they do not have enough dietary glucose to fuel fat breakdown efficiently. There are some negatives associated with ketones/more acidic state. That can easily be adjusted by adding just a bit more carb- to work together- probably an ideal small tweak for a person who is able to be very strict on a diet. Kind of makes good clinical sense even if the rest of the BG numbers are good. I don't think they are worried about you skyrocketing into ketoacidosis (in the presence of indogenous insulin-) but that you may be unnecessarily too strick in a way that may not serve your overall health optimally.
 
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Spiker

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@christi99 some good thoughts there. Though I think Prof Taylor has shown the existence of a non autoimmune mechanism for most, if not all, T2s.
 

christi99

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@christi99 some good thoughts there. Though I think Prof Taylor has shown the existence of a non autoimmune mechanism for most, if not all, T2s.
Well, my only reason for pondering the T2-autoimmune potential link (or as i said possibly a pro-inflammatory cellular destruction) is because many who have other autoimmune diagnoses can have higher levels of insulin resistance, dietary allergies, leaky gut etc.) - I know this isn't heavily researched or even scientifically accepted but it bears my consideration- as I have another autoimmune disease, have type 1.5 vs. 2 diabetes and my family is heavy in many different autoimmune diagnoses. And my son seems to have been born with type 2 diabetes, insulin resistance and hyperinsulinemia (I was gestationally diabetic). I have always been thin, active and healthy diet- every doctor says- "I don't understand this with you", you don't fit the profile etc., etc. Same thing with my bro. I think that we don't always medically know EXACTLY what is happening, and any doctor that say he/she does is not being forthright with how many assumptions or presumptions are made from previous research or even treatment protocols. Of course they still are constantly looking to unravel the mystery! The body is such a complex cellular machine- and we all have different genes etc. so... I am always just trying to "crack that nut" so I can get better control of my health. I guess i wonder about sudden autoimmunity (like a virus resulting in T1 versus a less rapid attack, and if any doctor is ever really looking BEFORE pathologic changes start to show up). Heck, I cannot get them to look deeper into issues that actually are happening!
I just think that no matter the type of DM, the management may be have different regimens for different people but always the same end goal- move glucose into cell, leave little glucose or insulin hanging around to wreak havoc in your system and try to minimize the damage that can occur from different metabolic states (i.e. renal, cardiovascular, vision, infection etc.) The same end damage is seen if you are T2, T1, T1.5 if not controlled well, as I have witnessed over the years.
 

christi99

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Type 2
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Oh and I will read more on Prof Taylor, thanks for mentioning it!
 

Daibell

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Well, my only reason for pondering the T2-autoimmune potential link (or as i said possibly a pro-inflammatory cellular destruction) is because many who have other autoimmune diagnoses can have higher levels of insulin resistance, dietary allergies, leaky gut etc.) - I know this isn't heavily researched or even scientifically accepted but it bears my consideration- as I have another autoimmune disease, have type 1.5 vs. 2 diabetes and my family is heavy in many different autoimmune diagnoses. And my son seems to have been born with type 2 diabetes, insulin resistance and hyperinsulinemia (I was gestationally diabetic). I have always been thin, active and healthy diet- every doctor says- "I don't understand this with you", you don't fit the profile etc., etc. Same thing with my bro. I think that we don't always medically know EXACTLY what is happening, and any doctor that say he/she does is not being forthright with how many assumptions or presumptions are made from previous research or even treatment protocols. Of course they still are constantly looking to unravel the mystery! The body is such a complex cellular machine- and we all have different genes etc. so... I am always just trying to "crack that nut" so I can get better control of my health. I guess i wonder about sudden autoimmunity (like a virus resulting in T1 versus a less rapid attack, and if any doctor is ever really looking BEFORE pathologic changes start to show up). Heck, I cannot get them to look deeper into issues that actually are happening!
I just think that no matter the type of DM, the management may be have different regimens for different people but always the same end goal- move glucose into cell, leave little glucose or insulin hanging around to wreak havoc in your system and try to minimize the damage that can occur from different metabolic states (i.e. renal, cardiovascular, vision, infection etc.) The same end damage is seen if you are T2, T1, T1.5 if not controlled well, as I have witnessed over the years.
In my experience many GPs including the two diabetes ones who have treated me are just not aware of Late onset T1 hence only know of people born with T1 or if older have T2. They have an extremely symplistic view of the world hence any desire to question further (even if they had the time) isn't there. DUK have a similar Black/White view of diabetes types. The result is that all the NHS statistics are probably worthless and there is a poor base to work from. DUK and others pour lots of money into research some of which is no doubt valuable but I wonder how many start from surveying people like us. Many of your points may be valid but until GPs and so on listen to their patients and research is based on what is actually happening out there I don't see knowledge changing fast. BTW I'm recorded by the NHS as a T2 despite always being thin but neither of my GPs took any notice that I was thin let alone recorded it as statistic. I supect my LADA was a virus or some other non-autoimmune inflammation as my white cell count was high 1 year before diagnosis This was discovered when I offered myself to a drug company as a non-diabetic 'victim'. One of the many bits of data lost on the NHS.
 
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christi99

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Type 2
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Tablets (oral)
In my experience many GPs including the two diabetes ones who have treated me are just not aware of Late onset T1 hence only know of people born with T1 or if older have T2. They have an extremely symplistic view of the world hence any desire to question further (even if they had the time) isn't there. DUK have a similar Black/White view of diabetes types. The result is that all the NHS statistics are probably worthless and there is a poor base to work from. DUK and others pour lots of money into research some of which is no doubt valuable but I wonder how many start from surveying people like us. Many of your points may be valid but until GPs and so on listen to their patients and research is based on what is actually happening out there I don't see knowledge changing fast. BTW I'm recorded by the NHS as a T2 despite always being thin but neither of my GPs took any notice that I was thin let alone recorded it as statistic. I supect my LADA was a virus or some other non-autoimmune inflammation as my white cell count was high 1 year before diagnosis This was discovered when I offered myself to a drug company as a non-diabetic 'victim'. One of the many bits of data lost on the NHS.
Ya exactly- great points. Even though I know docs are usually extremely smart people, they often really are pretty restricted in their thinking outside the accepted research- UNTIL something comes along to challenge what they thought they knew!!. Kind of funny story- about 30 years ago, I wrote a research paper linking folate deficiency and neural tube defects- My professor said my sources were not quality, that it was an erroneous and baseless premise etc. etc. (agreeably, I did use research that was a bit outside the box, but hardly witch doctor stuff!). Anyway, maybe 10 -15 years later= it is totally proven and a basis for treatment to supplement all pregnant and to be pregnant women with folic acid to help prevent neural tube defects!! SO...huh, who knew?

I get why doctors legally, ethically whatever, can't just prescribe or treat things outside a standard of practice- but they can acknowledge that much of what we know is either incomplete, wrong or will be better understood in the future- or will evolve into better treatments. The collection of data, or patient populations don't include us!
I have found naturopathic physicians to be able to incorporate the best of both worlds- unfortunately they don't take insurance usually ( in my country insurance is the gate-keeper unless you pay out of pocket) and if they do they operate more like a traditional western medical practitioner. I have been extremely frustrated dealing with 2 other autoimmune diseases I do have, because frankly- the specialists I go to don't have many tools in their tool box! I have had more progress when I proactively seek out nutritional, immune system, herbal whatever info to help address what I really do live with and want relief from. M.D.s they often look at a patient like a page out of a book- maybe for lack of time, interest or imagination! But... there is sooooo much out there that can help if we find what actually applies to us (as individuals) for ANY disease.
 
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Spiker

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Very good point that DUK would be well advised to do a grass roots survey of what is actually happening on the ground and use that to steer their research priorities. Their top down approach to research risks becoming increasingly out of touch.
 

christi99

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Very good point that DUK would be well advised to do a grass roots survey of what is actually happening on the ground and use that to steer their research priorities. Their top down approach to research risks becoming increasingly out of touch.
Ya - unfortunately where research monies are concerned or distributed, numbers matter, because there is more money to be made on pharmaceuticals- and unfortunately A LOT of the money used in research is received from private Pharma. i.e. new med, new findings, new target etc.- if it can be Rx'd to 10 million people versus help 1 million- they must always be competing to profit. Doctors are approached to do the studies in my country, and they do so as academic faculty etc.and it is expected of them to publish, but many studies are from medical equipment co's or big Pharma. Public grants just aren't going to be spent trying to help a few. Sadly many orphan diseases or drugs are not being used or developed for use because there just isn' t enough Pt base to make it profitable. Really it is just so ...wrong- on every level.
 

Spiker

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Ya - unfortunately where research monies are concerned or distributed, numbers matter, because there is more money
DUK is not a pharma company, it is a registered charity for diabetes support and research. Diabetes UK.
 

christi99

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DUK is not a pharma company, it is a registered charity for diabetes support and research. Diabetes UK.
Oh I know- I am just saying that most medical research is financed by big Pharma. NGO's and government funded research often follow where most promising stuff is being generated. I guess I am just saying medical research is lacking where it is not driven by potential economic gain.
 

Spiker

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Oh I know- I am just saying that most medical research is financed by big Pharma.
Yes, that's why I was not talking about Big Pharma (in the quote you replied to) but talking about DUK. :)

NGO's and government funded research often follow where most promising stuff is being generated.
Actually it's the other way around. There's no point non profits chasing after something commercial pharma is already having success with. And if they did there would be anti-competition arguments. Instead the non profits tend to blaze the theoretical trail and it's the commercial firms that move in on the action if it looks promising. Which is fine for the non-profits - that gives a multiplier effect to the value of their research. So it works reasonably when the non profits do the more unconventional stuff. If they turn up something that is exploitable, the commercial firms will allocate their resources. That's largely how DUK's research funding works - doing the riskier proof-of-principle stuff so that if it works, pharma will take notice and commercialise it.
 

christi99

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Yes, that's why I was not talking about Big Pharma (in the quote you replied to) but talking about DUK. :)


Actually it's the other way around. There's no point non profits chasing after something commercial pharma is already having success with. And if they did there would be anti-competition arguments. Instead the non profits tend to blaze the theoretical trail and it's the commercial firms that move in on the action if it looks promising. Which is fine for the non-profits - that gives a multiplier effect to the value of their research. So it works reasonably when the non profits do the more unconventional stuff. If they turn up something that is exploitable, the commercial firms will allocate their resources. That's largely how DUK's research funding works - doing the riskier proof-of-principle stuff so that if it works, pharma will take notice and commercialise it.
Well, I wish it was that way here but having worked for a teaching hospital, collecting data or working on research team, I have found that soooo much research being done in academic centers are still largely being funded by private companies and the docs just have to disclose the funding at time of publication. I think there is probably so many nontraditional treatments (herbal, or say other alternative approaches) that simply do not get researched and thus, will never be able to be prescribed in evidenced-based medicine. But as Archie Cochrane stated- lack of evidence does not necessarily mean lack of efficacy. I do understand the point your making- it just seems unlikely they (clinicians,researchers etc) will be very concerned with the outliers- whatever the reason.
 

mrbondsbody

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I recently got the results of my cholesterol test back from the GP.

My stats:

Total cholesterol= 8.3
HDL= 1.4
LDL= 6.0
Triglycerides= 1.4

I am a little concerned that my HDL is not improving relative to my LDL. I have been eating low carb since Jan and ketogenic since march (1 month).

My triglycerides came back at 1.4 which is brilliant. I knew that eating before the test would alter results when I had it done back in March.

My tri/HDL ratio is now excellent.

For more information: http://www.drsinatra.com/the-blood-lipid-ratio-everyone-should-watch/

This article is probably the most important:

A well respected doctors option on the matter: http://www.drbriffa.com/2013/08/23/research-finds-raised-cholesterol-to-be-associated-with-a-reduced-risk-of-death/

My TC/HDL is unchanged. But my LDL has slightly increased. So I am consulting with a private cardiologist to analyse the component of my LDL to see if its mostly harmless LDL-P or unwanted LDL-C.

If it comes back as the wrong type I will change my diet. But seeing as tri/HDL ratio is a good substitute it maybe the harmless type of LDL.

If not then because my current diet is controlling my blood glucose excellently and the risk markers are more favourable then I will continue my current diet with slight modications to try and alter my HDL to LDL ratio.
 
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